Unlike adults, chest pain in children is as or more likely to be caused by psychological factors than physiological ones.
This has been confirmed by a recent University of Georgia study, in which children diagnosed with non-cardiac chest pain showed higher levels of anxiety and depression than their healthy peers. While the observed levels of anxiety and depression weren't so high as to lead to a clinical diagnosis, statistically significant differences did show up between the two groups.
The study included 129 patients aged 8-18 years, all of whom were sitting in a cardiology office awaiting their medical diagnosis while they answered survey questions. Carried out in collaboration with Children's Healthcare of Atlanta and Emory University and published in the Journal of Pediatric Psychology, the results don’t make it clear whether anxiety causes pain or if pain happens first and causes anxiety.
In adults, chest pain is a serious condition that’s often linked to cardiac problems and requires medical intervention. On the other hand, less than 2% of children with chest pain receive a cardiac diagnosis.
Children with non-cardiac chest pain were unable to participate in everyday activities like running. They spent less time at school and were less involved in extracurricular activities than their normal counterparts. They also reported more physical symptoms with unclear causes, like joint pain, stomach aches, and headaches - all of which are known to be psychological manifestations of stress.
Psychological functioning is heavily related to pain, to the extent that the intensity of pain experienced depends on specific psychological and social factors. Previous studies have clearly shown that reducing emotional symptoms can help to cope better with pain.
Interestingly, children with non-cardiac chest pain also reported higher levels of anxiety sensitivity. This is a fear of experiencing physical symptoms, along with the additional fear that the symptoms may be related to a catastrophic health issue.
Clearly, screening for psychological along with medical factors is necessary when children show up at a hospital or clinic with this complaint. In other words - when children show up with chest or other unexplained pains, it is important that their physician take the time to sit down with them and their families to find out what they are most worried about, so that their psychological issues can be properly addressed.
Their chest pain may be real - but it is much less likely to be caused by physiological problems with their heart than psychological and social factors in their environment.